Intermittent or Short-term Restorative or Rehabilitative Services (in a Nursing Facility), up to 45 days; Restorative or Rehabilitative Services (in a place other than a Nursing Facility)

Long Term Acute Hospital Services (LTACH)

Maternal Infant Health Program Services (MIHP)

Mental Health Care (up to 20 outpatient visits per calendar year)

Office Visits to Your Doctor

Orthotic Services

Out of State Services, when Authorized

Outpatient Hospital Services

Parenting and Birthing Classes

Pharmacy Services

Podiatry

Preventive Services

Prosthetic Services

Sexually Transmitted Infection (STI) Treatment

Specialist Visits with Referrals

Therapy (speech, language, physical and occupational) Services

Tobacco Cessation Treatment, including pharmaceutical and behavioral support

Transplant Services

Transportation

Vision Services

You can call Customer Service at (888) 327‑0671 (TTY: 711) if you have any questions about the above services. If you do not understand the limits or if you are told something is not covered, please call Customer Service for more information.